The Effects of Mustard Gas on the Martyrs of the Imposed War and Its Comparison with Control Group

Sulfur mustard gas is an alkylating agent that is seriously toxic to the skin, eyes, respiratory tract and internal parts such bones and groins. Unfortunately, it has been used as a vesicant chemical warfare agent in the past and recently in the Iran-Iraq war.

The upper and lower respiratory tracts may be acutely damaged after its inhalation, and subsequently, a variety of chronic pulmonary sequelae may develop. Since the available literature is quite scanty in this regard, herein we present the chronic sequelae of sulfur mustard exposure after an acute and massive inhalation of this gas by a group of Iranian veterans in 1986.

MATERIALS AND METHODS

Those patients with respiratory symptoms whose exposure to mustard gas had been confirmed by studies on their urine and vesicular fluid (using the methods advocated by Heyndrickx et al in a special toxicology laboratory in 1986 were included. All these patients had their initial admissions in our university hospitals in 1986 because of the acute respiratory symptoms that included rhinorrhea, sore throat, hoarseness, cough, chest tightness, and dyspnea. Patients were included only if they had no history of exposure to other environmental agents known to cause interstitial lung disease or extrinsic allergic alveolitis. In the interim (1986 to 1996), all patients had regular follow-ups in a special outpatient clinic designed for these chemically injured veterans. Jobs such as painting, woodworking, welding, farming, milling, sculpturing, fire fighting, and baking were not allowed. Home visits and inspection of workplace were regularly done and all subjects were instructed to avoid exposure to asbestos, coal dust, silicone, or cotton dust. None of the patients worked in petroleum industries. Subjects with known asthma before their exposure to sulfur mustard gas) , cigarette smokers , and those with proven cardiovascular disease or other systemic illness were excluded from the study.

One hundred ninety-seven patients fufilled the above criteria and were enrolled into the study. In addition, 84 nonsmoker veterans who had participated in the war in another region in the same year (1986) but had no exposure to the mustard gas were voluntarily entered into the study as our control group.

Study Design

All subjects signed an informed written consent. Each patient was carefully examined. All patients had an ECG, a chest radiograph, and high-resolution CT (HRCT) of the chest. All HRCTs were performed with 1.0- or 1.5-mm-thick sections taken at 1-cm intervals throughout the entire thorax. Pulmonary function tests (PFTs) were measured through spirometric assessment. An experienced physician did all spirometric measurements for all the subjects using a spirometer . Each patient was trained to give his best effort. After 15 minutes of resting, three spirometric measurements were done at 1-minute intervals; the highest values were chosen and reported. Each patient underwent a bronchodilator study by a standard dose of inhaled agonist as well, and all tests were repeated again 15 to 20 min later.

The carbon monoxide diffusion capacity was also measured for each patient. Treatment with inhaled [Beta.sub.2]-agonist or inhaled ipratropium bromide was withdrawn for 8 h, and also treatment with anticholinergic agents, sodium cromoglycate, antihiastamines, beclomethasone inhaler, and theophylline was discontinued 2 days prior to each patient's examination and his PFTS. All patients underwent bronchoscopic examinations under appropriate and recommended precautions especially for asthmatic patients. The upper respiratory tract was anesthetized by 2% lidocaine. Atropine (0.75 mg IM) was given before the procedure. Patients who were labeled as being asthmatic or having severe chronic bronchitis received a continuous infusion of aminophylline, which was continued for 2 h after the termination of the procedure. Bronchial biopsy was done in all cases. Transbronchial lung biopsy was performed for only 24 patients whose spirometric data, chest radiographs, and HRCT of the chest were suggestive of interstitial lung disease. Biopsy specimens were obtained from all three lobes on the right side or from upper and lower lobes of the left lung.

Writer: Doctor Hussein Elyasi; Medical Science University of Shahid Beheshti, Taleghani Hospital, Home Section

Source: Information Base of Chemical Weapons Victims